Archives for USAID

When you think about mosquitos these days, one disease likely leaps to mind: Zika.

The media has been sounding the alarm about the virus for months, particularly in Latin America, where health workers are on alert for pregnant women who may have become infected.

But another mosquito-borne disease kills a child every two minutes — and sickens hundreds of millions more, often over and over again: malaria.

In Kenya, Christine Pepela sleeps under an insecticide-treated bed net provided by a local nurse. / Allan Gichigi, MCSP

In a rural health center in western Kenya, a 26-year-old woman waits her turn to see the nurse.

Christine Pepela began receiving prenatal care at the Mechimeru Health Centre in Bungoma County when she was four months pregnant.

It was here that she learned she is at risk for malaria — a far more deadly and prevalent mosquito-borne disease than Zika.

Now six months pregnant, Christine meets with Nurse Agnes Nambuya, who gives her an insecticide-treated bed net to sleep under and tells her about sulfadoxine-pyrimethamine, the medication she needs to help prevent malaria in pregnancy.

The risk of malaria faced by Christine and her baby is not new or unique.

In sub-Saharan Africa alone, 10,000 pregnant women will lose their lives to malaria this year, and about 200,000 babies born to mothers who have had just one episode of malaria in pregnancy will die.

In fact, malaria in pregnancy contributes to 8 percent of all stillbirths in the region. Many more babies will be born small or anemic, which can lead to life-threatening consequences, as well as health problems throughout childhood and beyond.

This is exceptionally unfair, as the adverse outcomes associated with malaria in pregnancy are largely preventable.

At the foundation of our efforts is ensuring access to high-quality, comprehensive prenatal care, which has proved effective in delivering critical care and counseling to both women and newborns.

It remains a key opportunity for trained health providers to deliver preventive treatment to pregnant women. Health providers can also recognize signs and symptoms of malaria, react swiftly, administer a rapid diagnostic test, and treat accordingly or refer to a higher-level facility.

With Zika virus cases mounting, prenatal care will be more critical than ever.

An estimated 94,000 newborn lives were saved through malaria in pregnancy interventions between 2009 and 2012.

As the world’s attention focuses on a newly emerging threat, we are reminded of the vulnerability of pregnant women to viruses and infections.

This underscores the importance of maternal and newborn health services to ensure all pregnant women receive the comprehensive counseling and care needed before, during and after pregnancy.

To learn more about the global efforts of the Maternal and Child Survival Program to prevent and treat malaria, click here. And to add your voice to the global conversation, join us on Twitter.

ABOUT THE AUTHOR

Elaine Roman is the Malaria Team Lead for USAID’s flagship Maternal and Child Survival Program.

Non-formal education serves as a critical bridge for out-of-school youth, connecting them to vocational training or allowing them to re-enter formal education after 10th grade.

In Jordan, this opportunity is much-needed for thousands of young people. At least 21,000 Jordanians ages 12 to 15 are not enrolled in school. In addition, Jordan hosts 80,000 school-aged Syrian refugees who are also out of school.

Youth who do not complete their schooling take the lowest-skilled, lowest-paying jobs and are often exposed to labor exploitation. They may resort to street hustling and suffer from social stigma, labeled as “failures” or “criminals.”

To help these youth, a new USAID program will expand non-formal education to 28 new school-based centers across Jordan. Together with the Jordanian government and our NGO partner, we will enhance the prospects of vulnerable, out-of-school youth, both Jordanian and Syrian.

Last month, I had the honor of speaking at the launch of our non-formal education program in Ma’an, Jordan. I met with 25 youth from across the governorate, one of the most impoverished areas in the country.

The youth I met at the center told inspiring stories of how the program boosted their confidence and deepened their self-esteem. These young men and women, Jordanian and Syrian, each had an inspiring tale of how their participation in the program and the mentoring they received transformed them.

In one classroom I visited, young men eagerly engaged in an anatomy discussion. In another, gregarious young women laughed and joked as they discussed their friendships and the surrogate family they have become. All were appreciative of the safe space and opportunity to learn in the program.

However, non-formal education is not the only way forward. Jordan’s Ministry of Education is committed to finding pathways to formal education for all out-of-school children. The Ministry will enroll an additional 50,000 Syrian refugee students in school for the 2016-2017 school year — in addition to the 143,000 who are enrolled in the current school year.

Later during my trip, I visited Jordanian youth from two leading youth organizations: Al Qantara and Future Makers. They were engaged in a USAID-sponsored youth and civic engagement initiative.

They discussed the challenges they face in their communities, their aspirations, and creative approaches to meeting these challenges. They spoke eloquently about the need for recreational facilities, more English language instruction, and a desire for more adult mentoring their lives.

They also expressed deep frustration at the stereotypes often raised about socially conservative governorate, Ma’an: “terrorists,” “trouble-makers,” “extremists.” Most powerfully, they spoke passionately about a way forward, brimming with positive ideas and energy — perhaps the most powerful refutation of those ill-conceived labels.

I came away from my trip inspired by the hope and dynamism embodied in these young people. Their energy and desire to succeed are a potent reminder of the promise of Jordan’s youth and the power of USAID’s partnership with the Jordanian people.

ABOUT THE AUTHOR

Mona Yacoubian is the Deputy Assistant Administrator for the Middle East Bureau at USAID.

An Afghan pupil reads a poem to her classmates at a girls school in Kabul. / Patrick Baz, AFP

Being transparent about how we spend U.S. foreign aid is necessary for effective and accountable development.

It benefits governments, civil society, citizens and donors alike. That’s why at a high-level forum in Busan, Korea in 2011, the United States joined others in voluntarily agreeing to publish timely, comprehensive and forward-looking information on development cooperation resources.

The United States became a member of the Open Government Partnership, a consortium of over 60 countries “committed to making their governments more open, accountable, and responsive to citizens.”

At USAID, we are delivering on that commitment.

After the Busan forum, USAID created a working group to produce a cost management plan to improve its reporting to the International Aid Transparency Initiative (IATI) — which developed a standard for publishing foreign assistance spending data, allowing for comparison across publishers.

We are doing more reporting and sharing foreign assistance financial data at foreignassistance.gov and in the IATI standard. We have doubled-down on strengthening the quality of our data, and are pushing hard to use it to drive evidence-based development that delivers the best results possible for people around the world.

The 2016 U.S. Aid Transparency Review, released today by Publish What You Fund, a United Kingdom-based NGO advocating for greater aid transparency, ranks USAID 19 out of 46 of the world’s major donor organizations.

It recognizes that we have made improvements since the last index; however, we feel that USAID’s “fair” rating does not fully reflect our commitment and progress since 2011.

To help inform the U.S. Government’s aid transparency agenda, USAID also conducted three aid transparency country pilot studies in Zambia (May 2014), Ghana (June 2014), and Bangladesh (September 2014).

The country pilots assessed the demand for and relevance of information that the U.S. Government is making available, as well as the capacity of different groups to use it.

USAID’s Cost Management Plan, released in July of last year, is proving to be an effective roadmap for us to continue making progress to improve data quality and reach maximum compliance in reporting to IATI.

For example, we have added 21 more fields to our quarterly reporting to increase our IATI compliance. We are also improving our internal reporting systems with the Development Information Solution, which is currently in development.

In addition to updating IATI compliance, the Agency has created Foreign Aid Explorer for better ease and use of aid information and is doing more work on geocoding and open data efforts.

We share Publish What You Fund’s perspective that aid transparency is fundamental to achieve development results.

Getting exactly to where we want to be on aid transparency is a marathon, not a sprint, and we’re not there yet. We are proud of efforts to date and remain fully committed to continuing to make significant progress on aid transparency.

ABOUT THE AUTHOR

Wade Warren is the Assistant to the Administrator for USAID’s Bureau for Policy, Planning and Learning.

Libya’s Constitutional Drafting Assembly members and media professionals participate in a press conference to discuss the constitutional development process and key constitutional issues.

For 40 years in Libya, Muammar Gaddafi pitted community against community and tribe against tribe to prevent any organized revolt.

Since the fall of Gaddafi’s authoritarian regime five years ago, a bruising battle over Libya’s national governance continues to test national leaders. The country has experienced ongoing damaging political divisions — even as national surveys continue to show the vast majority of Libyans seek a unified Libya with democratic governance. Only five years ago, there were no municipal governments in Libya at all. Now, newly elected municipal officials are working to fill the governance vacuum that existed at the national level. What’s unfolding now in the dry, southern desert city of Sabha highlights how Libyans are developing institutions at the local level and how the fate of the more than 6 million Libyans is evolving.

USAID supports consensus building for the national dialogue, constitution drafting and governing process in Libya.

A grassroots Libyan democracy emergesIn Sabha, the opening of a community center has enabled citizens to engage in the decision-making processes.The city’s mayor, Hamed al-Khayalee, describes the center as a neutral and accessible space for honest conversations between residents and local government leaders, nurturing the legitimacy of the local institutions. The community center has also been the site for training the municipal council on public relations to better enable councilors to inform the public, further increasing transparency and credibility.

This center is just one of the many ways that USAID is working to improve Libyan governance and build community cohesion. USAID has been in Libya since 2011 training newly elected leaders, facilitating input of Libyans into the constitutional drafting process, and strengthening elections.Woven through each of these activities is a concerted effort to bring Libyans from all walks of life together — often for the first time — over issues of mutual interest. In this way, stereotypes are broken down and Libyan cohesion can be forged. In another example, late last year we brought together 12 women municipal councilors representing the districts of Tripoli, Zawiya, Jabal al Gharbi, Benghazi and Wadi al Shati.Our goals were to build the technical skills of these local government officials, get a sense of what needs exist for female councilors, and set a foundation for the establishment of a Women’s Municipal Councilor Association.The women leaders discussed the principles of local governance, public service delivery, and the responsibilities of municipal councilors.

A participant of a gender and elections workshop engages men and women in discussion.

An End to AuthoritarianismLibyans want a legitimate and effective democracy in which individuals can live with freedom, dignity and opportunity. This is easy to agree upon. But real threats to unity exist from within Libya’s different factions, and especially in the form of extremist violence, foreign fighters and Da’esh.After generations of central government authoritarianism, these municipal officials represent a bridge from the past to a unified future — even as they build bridges to the east, south and the west of Libya.Five years after the overthrow of Gaddafi’s regime, Libya continues to struggle over competing interests that have had a disastrous impact on its people.USAID supports the brave Libyan men and women who agree that authoritarianism should not rise again, that the Government of National Accord and the Libyan-led, UN-facilitated Libyan Political Agreement is the only viable solution to the country’s political and security crisis.

Effective institutions encourage stability, and only through the genuine inclusion of all groups will there be Libyan prosperity.

I think I have the disease that everyone talks about. Other women warned me to be careful with my clients. My mind is buzzing with questions.

Where do I go to get help? Will people see me if I go to a clinic to get tested? What happens if I am positive? Will I die? Will I have to stop working?

I am afraid.

Jamilah, a sex worker in Kenya, is afraid of finding out her HIV status because of stigma and fear of living with the disease. She is unsure of how to get help and what will happen after she is tested.

In Bangladesh, a BRAC community health worker enrolls an expecting couple in theMAMA program so that they will receive informational SMS or Voice Messages during pregnancy and for the first year of life. / Cassandra Mickish, CCP/Courtesy of Photoshare

But a community health worker, Mariam, who is also a sex worker living with HIV, connects people in her community to the nearby HIV clinic.

Mariam meets with Jamilah and listens to her questions. She calms Jamilah’s fears. She sits with Jamilah at the clinic as she nervously waits to find out her status.

Through rapid testing at the clinic, Jamilah finds out she is positive. While the news is overwhelming and frightening, Jamilah is able to receive counseling and initiation of treatment from a nurse on the same day. The nurse teaches Jamilah how to manage her HIV for the rest of her life, including preventing transmission to partners and during pregnancy.

Feeling less afraid and supported by the community health worker and nurse she interacted with, Jamilah is empowered to face her HIV-positive status. Because she had a positive experience, Jamilah will return to the clinic regularly to monitor the disease.

A community care worker from Turntable Trust provides HIV counseling and testing service to a local woman at her home in South Africa as part of the national effort aimed at getting 15 million South Africans to know their HIV status. / JHHESA, CCP/Courtesy of Photoshare

Through the support of health workers, Jamilah is confident that she can live with HIV.

Community and facility health workers, like those in Jamilah’s story, are the backbone of health systems. They connect people to clinical services, provide emotional support, perform diagnostic tests, advise and counsel, and combat stigma by providing critical services to patients who need it most.

This week marks World Health Worker Week. As we thank the world’s health workers, it is also important to recognize the invaluable role they will play in the coming years as we look to achieving the Sustainable Development Goals (SDGs). Health workers will be a driving force towards achieving at least nine of the 17 SDGs.

A community health worker examines a child in Malawi. / SC4CCM/JSI/Courtesy of Photoshare

Health workers go beyond providing patient care; they also act as agents of socioeconomic development, leading countries to advance education and employment opportunities, especially for women, and increase the productivity of the population.

To keep a robust health workforce, systems and policies must be created to have health workers in the right places at the right time with the right support. Currently, the World Health Organization (WHO) is finalizing its Global Strategy on Human Resources for Health, which focuses in part on optimizing the existing health workforce.

Here at USAID, we are establishing programs in alignment with this strategy, focusing on optimizing health workers’ service delivery in order to reach an AIDS-free generation.

The global community is currently transitioning to new HIV treatment guidelines, known as Test and START, which will require a significant amount of support from health workers to be implemented.

These guidelines recommend starting antiretroviral therapy as soon as a person is diagnosed with HIV instead of waiting until the person gets sick from the disease. This means an additional 37 million people living with HIV are now eligible for this treatment. Expanding coverage is critical to achieving the 90-90-90 goals of the Joint United Nations Programme for HIV/AIDS.

Since most areas with high rates of HIV face health worker shortages, there is an urgency to evaluate the impact of health workers and how we train the existing workforce so they can better connect people with life-saving care and treatment for HIV.

The bottom line is that if we want to achieve an AIDS-free generation, a key component will be to better optimize the available workforce for HIV/AIDS services.

But what does optimization mean?

It means being creative and efficient about the way we use health workers based in hospitals, health clinics and communities to make HIV service delivery effective and sustainable.

It means investigating how community health workers, like Mariam, can be more effectively trained and distributed across communities and in healthcare facilities to support outreach and testing.

It means figuring out how to be more effective in administering antiretrovirals at all points of care, such as communities, health clinics and hospitals.

It means improving the quality of training for laboratory workforces and creating efficient lab systems to support health workers in scaling up viral load testing.

It means examining the skill mix of doctors, nurses, midwives, and community-based health workers to meet the needs of all patients, including adolescent girls and other key populations.

As we celebrate health workers this week and honor their important role in creating healthy, resilient and productive societies, we must direct our focus and investment to overcoming key barriers so we can maximize their impact.

Jamilah and millions of others living with HIV and AIDS are counting on us.

ABOUT THE AUTHOR

Shayanne Martin, Diana Frymus and Kim Rogers are members of the Health Workforce Team in the Office of HIV/AIDS at USAID. Follow them on Twitter at @ShayanneMartin and @DianaFrymus.

“When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days. I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back…only then did they know it was tuberculosis.”— Atsede Tefera

Atsede Tefera with her daughter, Nigist, who was diagnosed with tuberculosis at a hospital in Addis Ababa, Ethiopia. / MSH Ethiopia

Atsede Tefera, photographed above, recalls three months of long delays in the diagnosis of tuberculosis for her daughter Nigist, who was eventually able to start treatment for the disease.

Tuberculosis (TB) kills more people each year than any other infectious disease, causing over 1.5 million deaths globally in 2014 alone. More than a quarter of cases are in Africa, the region with the highest burden of TB disease relative to population.

Children are among the most vulnerable, and all too often children with TB remain in the shadows, undiagnosed, uncounted and untreated. Today, more than 53 million children worldwide are infected with TB, and more than 400 die each day from this preventable and curable disease.

This global childhood TB epidemic is serious, yet historically neglected. Some children get TB at the same time as other chronic illnesses, such as malnutrition, making it even more lethal. However, TB is preventable through prompt diagnosis and treatment.

TB is an airborne disease, which is passed between people with symptoms by coughing or sneezing. TB often spreads in communities where people are living in close proximity to each other, putting those living in poor socio-economic conditions particularly at risk.

Children living with a parent who is diagnosed with TB should be systematically screened for infection. They should either be put on prophylaxis treatment, or if they start to cough, those cases should be identified early on. / MSH Uganda

In recent years, progress has been made to combat childhood TB. The emergence of policies and guidelines across the Africa region that incorporate childhood TB, coupled with innovative treatment and child-friendly medicine, have moved us closer to tackling one of the oldest and most persistent diseases in the world.

However, a new analysis released today on World Tuberculosis Day, shows that in African countries, a persistent divide between policy and practice threatens to impede progress gained for addressing childhood TB across the region.

The analysis, a collaboration between USAID and its African Strategies for Health project, presents the landscape of childhood TB programming in 12 countries in Africa, and suggests three focus areas critical for moving the dial on this intractable issue:

Strengthen the capacity of health workers to identify and diagnose children infected with TB. For children, the first contact with the health sector at a primary health care or maternal and child health clinic is an important opportunity to identify TB symptoms early and refer for treatment. Symptoms — such as a persistent cough, loss of appetite and high fevers — must be recognized by all providers as possible signs of TB. Health workers at all levels of the health system must be empowered to take appropriate action, such as referral for treatment and follow-up.

Implement active case finding strategies for early identification of child TB. Delays in diagnosing TB and initiating appropriate treatment are often long, particularly where access to health care is poor. Systematically identifying children who have come into contact with a person with active TB, as well as screening children with HIV and those who are malnourished, are critical steps to identify sick children.

Ensure adequate care closer to home. Health systems must be strengthened to guarantee a regular supply of diagnostic tools and child-friendly medicines at all levels where sick children may access care. Clear guidance on the optimal interaction and links between service delivery platforms — including maternal and child health, HIV, and nutrition programs — is vital.

No child should die from TB, which is preventable and curable. We have the policies, guidelines, medicines, and health service delivery platforms needed to make this vision a reality. The time to apply these instruments – to end preventable child deaths due to TB – is now.

Imagine giving birth without the help of sterile tools, a doctor, nurse or midwife. This is the experience of nearly half of women giving birth in low-income countries — and many are at high risk of infection. With limited access to antibiotics, these infections often prove fatal.

One woman is trying to change that.

Zubaida Bai, founder and CEO of ayzh, speaking at USAID’s Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai is the co-founder of ayzh, an organization providing women’s health resources to underserved women globally. The venture’s first product is a clean birthing kit that includes all the items recommended by the World Health Organization to prevent infection at birth.

Infections at birth affect more than 6 million women annually. Even worse, poor hygiene and sanitation during birth is directly linked to the preventable deaths of more than 1 million women and newborns each year.

In celebrating International Women’s Day earlier this month, we recognize women like Zubaida who are revolutionizing their field and making history with their achievements. With the support of USAID and other organizations, Zubaida’s work establishing ayzh has saved the lives of women and newborns on a global scale.

Zubaida posing with the clean birthing kit. / Ayzh

This is her story: After earning her engineering degree, Zubaida Bai decided to go back to India to serve the women she had seen suffer her whole life from health and financial hardship.

She worked in India for four years developing technology appropriate for low-resource settings, before she decided to spin off on her own. Both Zubaida and her husband Habib were passionate about helping women, so they started looking for opportunities to design for this underserved population.

On a field visit to a rural village, Zubaida discovered that some midwives used a sickle — normally used for cutting grass — to cut the umbilical cord. This was an “aha” moment for her.

Reflecting on the infection she contracted when her first child was born in one of the best facilities in India, she thought, “If I had everything and had to suffer an infection, what would women in these villages be facing?” This is the moment that launched Zubaida into a whole new world of maternal health.

“It made me very determined to make my childhood dream come true – to improve the lives of women,” she said in a blog for TED.

In 2007, Zubaida and her husband participated in MIT’s International Development Design Summit, a program that brings together people from across the globe to collaborate and build projects that address issues faced by the world’s poorest communities. The program exposes participants to practical design for development.

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

After studying how to best succeed in markets in developing countries, Zubaida founded ayzh in 2009 and a year later launched the clean birth kit. She called it “janma,” which means “birth” in Sanskrit. The $3 purse comes with six items to ensure a safe and sterile delivery at half the cost of comparable birth kits.

Ayzh hires local Indian women to assemble the packages, allowing them to develop a stable income. Since 2010, about 250,000 kits have been sold in India, Afghanistan, Gambia, Laos, Ghana, Malawi, Nigeria, Zambia, and Haiti — reaching 500,000 mothers and babies.

Ayzh plans to reach 6 million women over the next five years, improving maternal health and breaking the cycle of poverty one woman at a time.

With support from USAID’s Higher Education Solutions Network (HESN) through MIT’s International Development Innovation Network, ayzh is developing a similar kit for newborns. It will provide the tools necessary to make transitions for new mothers and their babies as smooth and healthy as possible.

Through HESN, USAID is empowering entrepreneurs and researchers at universities so that people like Zubaida can get the funding and mentoring they need to jump start their ventures.

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Last year, ayzh was selected to be a part of a cohort of innovators at the Social Entrepreneurship Accelerator at Duke — another HESN partner — to receive mentorship and capacity building to expand their global reach and impact. The Evidence Lab at Duke is providing support to ayzh to find the best ways to measure and communicate its impact.

With the support of USAID and other organizations, we hope this venture and others like it will continue to improve the health of women around the world.

ABOUT THE AUTHOR

Danielle Somers is a communications analyst for the U.S. Global Development Lab’s Higher Education Solutions Network (HESN). Emily Jablonski is a virtual intern for HESN and student at the University of Michigan.

Sitting around a conference table in Somerville, Massachusetts, many heads nodded. “Yes,” these bobbing heads seemed to say, “We have that problem, too. Yes — we, too, are being affected.”

As Oscar Montes, director of the Municipal Office of Environment, discussed the increasing storms, worsening floods and shrinking coastline that his city La Ceiba, Honduras was experiencing due to climate change, he clicked through a number of photos.

Mothers carrying children on their shoulders through flooded streets. Shopkeepers using buckets to empty their markets of water in vain. Satellite images of an eroded coastline. Photos of houses crumbling into the sea.

Coastal cities like La Ceiba, which is home to a quarter of a million people, have always been vulnerable, but the effects of a changing climate are accelerating these threats.

You might not think that Somerville and La Ceiba have much in common, but after sitting in on a few hours of conversation between these two cities’ officials, it was abundantly evident they face similar problems, and they can help each other find solutions.

This is the key theory behind USAID’s support to the CityLinks program, implemented by the International City/County Management Association, which partners cities to share best practices for adapting to climate change.

Across the conference table, Oliver Sellers-Garcia, director of Somerville’s Office of Sustainability and Environment, translated Oscar’s presentation for his colleagues, adding his own commentary throughout.

“Oscar says that the hardest hit parts of La Ceiba are those in the urban center, where most of the population lives in the flood zone. When there are flash floods from the nearby rivers and streams, the neighborhood groups notify the city. Guys, this is something we can actually learn from La Ceiba and start doing here.”

Later in the day, Somerville’s director of Capital Projects and Planning, Rob King, showed Oscar how the city is adapting to increased rainfall.

As in many cities in the United States, storms overwhelm Somerville’s sewer system, which collects both sewage and stormwater runoff. When there is too much water for the city’s treatment plant to handle, both runoff and raw sewage get dumped into local bodies of water.

“We can put holding tanks underground to temporarily capture the stormwater that would otherwise flood our city’s sewage system, but that’s expensive,” Rob said. “We can create plant- and grass-filled medians in the roadways and direct runoff there, but that means less room for pedestrians, cars, bicyclists…”

There are no easy answers, and Oscar knows this all too well. In La Ceiba, the wastewater treatment facility’s pumps fail every time there’s a storm, spewing raw sewage into the ocean. With more storms expected in La Ceiba due to climate change, the city is trying to find affordable solutions to prevent this from happening.

More than half the world’s population lives in cities, and that number is growing at unprecedented rates. The urban poor are especially vulnerable to the effects of climate change, living in unsafe housing and in areas most prone to flooding.

By partnering cities facing similar challenges, USAID helps them to increase their resilience, protect their citizens and prepare for a changing climate.

ABOUT THE AUTHOR

Nancy Leahy Martin is an Urban Advisor in USAID’s Engineering and Urban Division. Follow her at @LeahyNancy.

In 1960, more than 22 percent of all children in developing countries — one out of every five — died before the age of 5. Today, we are within reach of ending preventable child deaths

Across developing countries, when compared with 50 years ago, people are living longer, more people are educated, there are fewer wars, and there is an unprecedented drop in both the number and rates of people living in extreme poverty.

At the same time, Ebola and Zika are drastic reminders of our human frailty and the need for vigilance and responsiveness — in all countries, and at all levels of care, down to every community, every family. The survival and safety of the women and children of the world require us to find ways to link families and communities to the knowledge, behaviors and treatments that can help them survive, thrive and transform the world they live in.

Enter community health workers. For years, they have been vital in strengthening maternal and child health, preventing the spread of infectious diseases, and promoting sanitary behaviors. They will play a critical role in helping us achieve the Sustainable Development Goals.

Community health workers play an important role in USAID’s efforts to end preventable child and maternal deaths. / MCHIP/MCSP

Unlocking the potential of community health workers

Seeking to unlock the potential of community health workforces in post-Ebola Africa, 50 development practitioners, thinkers, experts and funders gathered two weeks ago in Wilton Park in England. Ministry and NGO practitioners presented models developed and being improved in several countries.

Three thoughts emerge:

Inspiring models of community health workforces already exist – which smart, experienced people are striving to make even better through policy improvements, strengthening supervision, leveraging technology and introducing long-term domestic financing.

There is not yet a simple, systematic way of sharing good practices across countries; we need to be able to compare solutions that could be replicated and scaled faster, smarter or more affordably.

We have not yet cracked the nut of financing. There is an urgent need for national governments and development partners to substantially increase investment in community health workers as part of integrated health care systems. We need financing solutions to be shared, adopted and adapted, as well as spur thinking on new ones.

A framework for community health

My colleagues and I shared the first version of a Community Health Framework with participants to jumpstart a “common language” on community health.

This first framework highlights some laudable models and tools; it’s simple to navigate and understand. It acts as an interactive learning tool to help practitioners and ministries better appreciate why we should care about community health, how to approach community health, and where to find successful examples.

The framework also offers a way of acting in a common ecosystem. In order to be successful, any country — whatever its circumstances — should follow a five-step process: identify target health outcomes, understand the existing system, analyze barriers, develop or strengthen programs and ensure oversight, monitoring and evaluation.

We urge our colleagues to consider leveraging this common language in their own work, so we can begin to find commonalities and ways to better scale and replicate.

In Senegal, community health workers provide essential services at local health posts and promote healthy activities within their communities. / Jane Silcock, USAID

It’s a time to be bold

This was the warning we heard at Wilton Park: “The acute crisis of Ebola may be over, but sustained crisis and emergency still exist.”

We cannot afford not to invest in community health workforce development. Strong political will and leadership, smart investment and coordinated planning are just a few of the critical components. The private sector has much to offer — both in terms of investment and bringing strong business models for sustainable solutions.

This is the time to be bold and to be practical. Two weeks ago, we set out broad principles to achieve strong community health workforce development. As we closed the conference, I felt inspired by the commitment and passion shared by those in the room

As one of our colleagues said, “It is not easy; it requires collaboration and determination, but we know what needs to be done — now let’s go and do it.”

ABOUT THE AUTHOR

Katie Taylor is USAID’s Child and Maternal Survival Coordinator and Deputy Assistant Administrator in the Bureau for Global Health.

Ending the HIV/AIDS epidemic can only be achieved with multiple prevention options that meet women’s needs and fit within the context of their lives./Kate Holt/Africa Practice

HIV/AIDS is the leading cause of death worldwide for women of reproductive age.

Even with marked improvements in HIV treatment, women — especially those ages 15-24 — continue to be at a disproportionately high risk of HIV infection throughout Africa. In fact, in some parts of Africa, young women are more than four times more likely than men to become infected with HIV.

There are structural drivers that directly and indirectly increase women’s HIV risk, including poverty, gender inequality, sexual violence and a lack of education. Many women face unequal access to reproductive health services, including HIV/AIDS education, diagnostic services and treatment programs, putting them at an increased risk of contracting HIV.

Gender norms can also discourage women from asserting control over the timing and circumstances of sex, including negotiating protection against HIV using common prevention methods, such as condoms.

Women need HIV-prevention options that are discreet, do not need their partner’s agreement to use, and that are easy to access and convenient to use.

The Ring Study findings may give new hope to women who need diverse options to protect themselves from HIV and AIDS./ Matthew Willman/Oxfam, Courtesy of Photoshare

Results released today at the Conference on Retroviruses and Opportunistic Infections in Boston show we are one step closer to having a new prevention tool exclusively for women that fits within the context of their lives.

The Ring Study looked at women’s use of a simple vaginal ring, which is prescribed by a doctor and self-inserted to provide 30 days of continuous, sustained release of the antiretroviral dapivirine. The study found the dapivirine ring helped protect against HIV during vaginal sex among women ages 18 and older.

The monthly dapivirine ring is a longer-acting HIV prevention method specifically designed for women, who bear the greatest burden of the global HIV/AIDS epidemic./ Molly Snell, Courtesy of Photoshare

The Ring Study showed that the monthly dapivirine ring safely reduced HIV infection overall by 31 percent compared to a placebo. Similar results were seen in a sister study, known as ASPIRE. ASPIRE found that the ring safely reduced infection by 27 percent overall. This is the first time that two large clinical trials have yielded statistically significant results in finding that a microbicide can protect against HIV infection.

However, we must recognize that these results are only the starting point for further research. Despite both the Ring and ASPIRE studies showing a statistically significant protective effect against HIV, the dapivirine ring did not reduce infection quite as much as researchers had hoped. While disappointing, we should see this as an opportunity to gain more information in order to create a more effective HIV-prevention product.

To do this, researchers need to look closely at the information collected during the study to figure out why there wasn’t a bigger effect: Was the dapivirine ring itself not as effective in the women in the study? Were women not able to use the product consistently? So far, we know that women who used the ring more had a lower chance of becoming infected with HIV, but we need more information to say for certain.

It is particularly important to understand the influence of consistent use of the dapivirine ring on the study results for younger women. If we look at the Ring Study results broken down by age, women 18-21 years had only a 15 percent reduction in infection, while women older than 21 had a 37 percent reduction.

If younger women, who are at the highest risk of infection, are not able to use the dapivirine ring consistently, we need to understand why and look at whether different marketing, education or additional interventions could improve use and, as a result, decrease their risk of infection.

While the Ring Study’s results have raised many new and important questions, ultimately, the dapivirine ring is the first longer-acting and discreet female-controlled HIV prevention method that has been shown to safely offer protection.

Innovative prevention methods like the dapivirine ring could offer an important additional prevention tool for women unable or unwilling to use other strategies.

If we hope to achieve an AIDS-free generation by 2030, we must continue to invest in products that empower women across the world to protect themselves from HIV.

ABOUT THE AUTHOR

Elizabeth Russell PhD, MSc, is a Senior Advisor for Biomedical Prevention Technologies in the Research Division of the Office of HIV/AIDS. She provides technical assistance for pre-clinical and clinical research projects supported by USAID for new microbicide products.